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Martina de Witte, Hod Orkibi, Rebecca Zarate, Vicky Karkou, Sabine Koch, Nisha Sajnani

Mechanisms of Change in the Creative Arts Therapies

Creative arts therapies (CATs) have demonstrated a rapid growth of empirical studies over recent decades. While the findings of these studies substantiate that CATs have positive impact on a range of outcomes, it remains unexplored how and why CATs account for these effects. To gain more insight into why and how CATs impact outcomes, it is important to pinpoint which therapeutic features of CATs are unique and essential (specific factors) and which features are generic (common factors). To provide an overview of the assumed change factors or mechanisms of change and to gain more insight into how or why CATs may lead to psychological and physiological outcomes, the presenters/authors of this symposium have conducted a scoping review (De Witte et al., in prep). In this masterclass / mini symposium, we will share the findings of this review and discuss how these findings can positively influence the development of both CATs theory, research, and practice, as well as training and education.

Plenary presentation- the participants will gain knowledge on the following questions:
What are change factors / mechanisms of change (common factors versus specific factors)? What do these terms mean in the context of CATs?

Which change factors and MoC are unique to each CATs modality and which are shared across modalities
What are the implications for clinicians, trainers, and researchers?

Small groups by CAT modalities - objectives:

Getting familiar with the sequence of Intervention – Change Factor – Outcomes.
After presenting some of these sequences from our review, participants will be invited to employ their new understanding to their practice as clinicians, trainers, and/or researchers.

Awareness of specific intervention components / characteristics: how can they influence outcomes?
Discussion: how can knowledge of change factors / mechanisms of change, positively influence the (further) development of CATs practice, training program and research?


Martina de Witte

Martina de Witte, MA, MT-BC, PhD candidate, is lecturer and researcher in Music Therapy and coordinator of Research & Innovation at the Bachelor/Master program of Music Therapy of HAN University of Applied Sciences in Nijmegen, The Netherlands. She is a senior certified music therapist at STEVIG (The Netherlands), a mental health institution for psychiatric treatment for people with mild intellectual disabilities. In partnership with the University of Amsterdam, HAN University and the research group KenVak, she runs a PhD program. Her PhD program is focused on the effects and applicability of music therapy interventions on stress regulation. The main focus of her work is to bring together the latest scientific evidence about the effects of music on stress regulation with everyday practice of music therapists and other professionals.

Hod Orkibi

Hod Orkibi, PhD, is a certified psychodrama therapist, a tenured Senior Lecturer and the Chair of the Doctoral Studies Committee at the School of Creative Arts Therapies, University of Haifa, Israel. His research areas include psychodrama/ drama therapy, creativity, and well-being; therapy process and outcomes; arts-based community rehabilitation; positive psychology; and therapists’ training. Hod has secured several competitive grant funds, has published over 50 articles in refereed journals, and his work has been presented at international conferences. He is a member of the Israeli Association for Arts Therapies (YAHAT), Israeli Association for Psychodrama, former Chair of the Israeli Higher Council for Creative Arts Therapies, and currently an Executive Committee member and Council representative of the Society for the Psychology of Aesthetics, Creativity, and the Arts (Division 10 of the American Psychological Association).

Rebecca Zarate

Dr. Zarate is a music psychotherapist, musician, researcher, and educator of music therapy and the arts therapies. Her research focuses on social anxiety and improvisation-based music therapy with young adults. Dr. Zarate is interested in the clinical, social, and cultural intersections of anxiety, and writes and presents on this from clinical, critical, and cultural perspectives. She is dedicated to translating clinical and educational knowledge of music as a health mechanism into the greater community through the intersections of cross-discipline, interdisciplinary collaborations, and arts technologies. This is reflected in her teaching and pedagogy of art therapies research. Her music and health research lab includes faculty and students in expressive therapies who work together on the inquiry of music and arts, and the global social issues of the rising impact of anxiety and stress. Projects have included addressing manipulation of truth, ‘Alternative Facts’ and the Me/2 movement. The lab addresses the impact of using a critically conscious lens in aesthetics as a transformative tool for clinical and performance pedagogy. This includes her own concept of ‘collective anxiety’ and music-centered technique of tracking moments of interest, mediators, and mechanisms of change, and transitions within clinical improvisation and critical social aesthetics frame.

Felicity Baker

Felicity Baker is Professor and Head of Music Therapy at the University of Melbourne. Felicity has 28 years of practising and researching in the area of music therapy with a focus on neurorehabiitation and dementia care. Felicity is currently lead investigator on 3 National Health and Medical Research Council grants, including the Homeside International Randomised Control Trial which she will tell you about today. Felicity is committed to leading research that will lead to evidence-based practice, scalable implementation, and that can influence aged care policy.

Vicky Karkou

Prof Vicky Karkou, Edge Hill University, UK. Vicky is the Director of the Research Centre for Arts and Wellbeing at Edge Hill University and the co-founder of the Arts for the Blues project. She works across performing arts and health, sharing her time equally between these two subject areas. She is a qualified dance movement psychotherapist, humanistic psychotherapist and qualified supervisor, currently co-leading the MSc in Psychotherapy and Counselling: Contemporary Creative Approaches. Vicky is widely published in peer reviewed journals and edited books, and is co-editing the international journal Body, Movement and Dance in Psychotherapy published by Taylor and Francis.

Sabine C. Koch

Prof. Dr. phil. habil. Sabine C. Koch, Psychologist and Dance Movement Therapist. Director of the Research Institute for Creative Arts Therapies (RIArT) at Alanus University Alfter. Professor for Dance Movement Therapy (DMT) at SRH University Heidelberg, evidence-based research and change factor research in Creative Arts Therapies. Her research interests are in the area of embodiment and related theoretical approaches such as enaction, dynamic systems theory, ecological approaches, which understand the human condition as based upon its organismic nature with its capacity for self-organization and interactional resonance. This approach is applied in the area of creative arts therapies, where music, art, dance, theatre, poetry, and play are used for promoting physical, social, and psychological health and body mind unity.

Girija Kaimal

Dr. Girija Kaimal is an Associate Professor in the College of Nursing and Health Professions at Drexel University and President-Elect of the American Art Therapy Association. Her research broadly examines the physiological and psychological health outcomes of visual and narrative self-expression. Her Health, Arts, Learning and Evaluation (HALE) Lab is funded by the U.S. Department of Defense, the National Endowment for the Arts as well as University research groups. Current studies include: Examining the role of art therapy in adult and pediatric hematology/oncology settings; the impact of art therapy for military service members with traumatic brain injury and post-traumatic stress; the role of narratives and portraiture to enhance awareness on Gulf War Illness; indigenous and traditional arts practices; and the applications of new media like virtual reality in promoting creative approaches to health and well-being. Girija has published over 50 peer reviewed papers and was recently included in the list of the top 100 women in science. Girija is also an active visual artist and more details on her work are available at

Bani Malhotra

Bani Malhotra, MA, ATR is a registered art therapist and currently a Ph.D. student in the Creative Arts Therapies Department at Drexel University, Philadelphia. She holds master's degrees in Art Therapy and Psychology with experience working with adults, children, and adolescents in varied clinical settings in India and the USA. Her current research interests are medical art therapy, interprofessional relationships, and mechanisms of art therapy. Bani has also worked and published works on art therapy with the forensic population and neurodevelopmental disorders like Autism Spectrum Disorders.

Nisha Sajnani

Dr Nisha Sajnani . is the Director of the Program in Drama Therapy and the Theatre & Health Lab at New York University. She is the Principal Editor of Drama Therapy Review, the journal of the North American Drama Therapy Association.

Recent publications

De Witte, Da Silvo-Pinho, Stams, Moonen, Bos, & Van Hooren (just accepted). Music Therapy for Stress Reduction: A Systematic Review and Meta-Analysis. Health Psychology Review.

Orkibi, H., & Feniger-Schaal, R. (2019). Integrative systematic review of psychodrama psychotherapy research: Trends and methodological implications. PLOS ONE, 14, e0212575.

Karkou, V., Aithal, S., Zubala, A., & Meekums, B. (2019). Effectiveness of dance movement therapy in the treatment of adults with depression: A systematic review with meta-analyses. Frontiers in psychology, 10, 936.

Baker, F.A., Tamplin, J., Rickard, N., Ponsford, J., New, P.W., & Lee, Y.E.C. (2019). A therapeutic songwriting intervention to promote reconstruction of self-concept and enhance well-being following brain or spinal cord injury: pilot randomized controlled trial. Clinical rehabilitation, 33, 1045-1055.

Kaimal, G., Mensinger, J.L., & Carroll-Haskins, K. (2020). Outcomes of collage art-based and narrative self-expression among home hospice caregivers. International Journal of Art Therapy, 1-12.

Koch, S.C. (2017). Arts and health. Active factors and a theory framework of embodied aesthetics. Arts in Psychotherapy, 54, 85-91.

Malhotra, B. (2019). Art Therapy With Puppet Making to Promote Emotional Empathy for an Adolescent With Autism. Art Therapy, 36, 183-191.

Sajnani, N. (2019). Make art (not) after war: The role of the creative arts therapies in the treatment of trauma. Arts in Psychotherapy, 62, 5-6.

Zarate, R. (2016). Clinical improvisation and its effect on anxiety: A multiple single subject design. The Arts in Psychotherapy, 48, 46-53.

Ho, R.T., Fong, T.C., Chan, W.C., Kwan, J.S., Chiu, P.K., Yau, J.C., & Lam, L.C. (2020). Psychophysiological effects of dance movement therapy and physical exercise on older adults with mild dementia: a randomized controlled trial. The Journals of Gerontology: Series B, 75, 560-570.

Koch, S.C., Riege, R.F., Tisborn, K., Biondo, J., Martin, L., & Beelmann, A. (2019). Effects of dance movement therapy and dance on health-related psychological outcomes. A meta-analysis update. Frontiers in psychology, 10, 1806.

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